Boards and Commissions Online Application

This form has been modified since it was saved. Please review all fields before submitting.

NAME:*

WORK #:

ADDRESS:*

HOME #:*

E-MAIL:*

SPOUSE'S NAME (optional):

Resident (# of years):*

Registered Voter # or Date of Birth:*

Voter Precinct #:*

If less than 2 years: prior address

Length:

Occupation:

Employer:

Address (optional):

If any previous Board or Commission experience (in any City), state details:

If any previous Board or Commission experience (in any City), state details:

List any particular qualifications which you think might be beneficial in serving on a board:

Boards & Commissions (select your first preference)*

Boards & Commissions (select your second preference)*

By signing below, I acknowledge that Farmers Branch Code of Ordinances 2-33 requires that I agree to the City performing a criminal history check on me prior to my appointment to a board or commission and hereby grant my consent to the performance of said criminal history check.

I understand and acknowledge that if I am appointed to a board or commission, the Texas Public Information Act (Tex. Govt. Code 552.001, Et. Seq.) may require the City of Farmers Branch to disclose personal information in its possession to members of the public who make written requests for such information unless a public access form is on file.

Electronic Signature:*

Date:*

Date:

DISCLOSURE & AUTHORIZATION FOR CONSUMER REPORTS

Please read the following statements carefully.

In connection with my application for volunteer services with the City of Farmers Branch, Texas ("Company"), I understand consumer reports will be requested by Quick Search ("Agency"). These reports will ONLY include criminal records. If I am accepted, I understand that the City of Farmers Branch can use this disclosure and authorization to continue to obtain such consumer reports throughout my volunteer service.

AUTHORIZATION: I hereby authorize procurement of consumer and investigative reports(s) by Company from Agency. If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for Company to procure such reports at any time during my volunteer period. I authorize without reservation, any person, business or agency contracted by the consumer reporting agency to furnish the above-mentioned information.

This authorization is conditioned upon the following representation of my rights:

I understand that I have the right to make a request to the consumer reporting agency: Quick Search ("Agency"), 4155 Buena Vista, Dallas, TX , 75204, telephone number 214.358.2880 ext 114, upon proper identification, to obtain copies of any reports furnished to Company by the Agency and to request the nature and substance of all information in its files on me at the time of my request, including the sources of information, and the Agency, on Company's behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by any investigative consumer report(s). The Agency will also disclose the recipients of any such reports on me which the Agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request (California three years). I hereby consent to Company obtaining the above information from the Agency. I understand that I can dispute, at any time, any information that is inaccurate in any type of report with the Agency. I may view the Agency's privacy policy at their website: www.quicksius.com.

I understand that I have rights under the Fair Credit Reporting Act (which are being used for the sole purpose of acquiring criminal background checks), and I acknowledge receipt of the FCRA Summary of Rights.

Initials:*

Applicant Electronic Signature:*

Date:*

Date:

AFTER RECEIPT OF CONFIRMATION EMAIL:

***After submitting this application, please complete the process by going to fbboards.com and click the ‘Quick Search’ link to proceed to the criminal background check website. The criminal background check is required for all boards, commissions and volunteers.***